Published by EH.Net (April 2022).

David Courtwright. The Age of Addiction: How Bad Habits Became Big Business. Belknap Press, 2019. ix + 325 pp. $27.95 (hardcover), ISBN 978-0674737372.

Reviewed for EH.Net by Emily Dufton, author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (2017).


As late as the 1960s, historian David Courtwright notes in his erudite and witty new book The Age of Addiction: How Bad Habits Become Big Business, “people swam in waters in which there were relatively few addictive hooks. Chief among them were cigarettes, alcohol, and drugs.” The first two hooks were powerful and widely used – half a trillion cigarettes were sold in 1962, and anyone who has seen Mad Men knows the culture of alcohol consumption at the time – while the use of licit and illicit drugs, though growing, was limited only because “the last were expensive, risky, and often hard to obtain” (p. 206).

But over the course of the next six decades, the waters were filled with many more hooks. New and even more enticing intoxicants took advantage of technological shifts: cocaine morphed into crack, caffeine and alcohol into Four Loko, heroin into fentanyl. Other temptations also appeared. The size of a typical American meal ballooned, and the sugar and salt levels of cheap and ubiquitous snack foods exploded. In the internet age, screens gave us instant access to gambling, porn and shopping, and to apps that delivered hits of dopamine with likes and retweets. By 2019, when Courtwright published his book, the waters were so thick with tempting hooks that there was rarely a place to swim without one.

It would be almost impossible to avoid these hooks anyway, since everything on them was purposefully designed to appeal to humanity’s greatest strength and flaw: our limbic system, “the part of the brain responsible for feeling and for quick reaction, as distinct from dispassionate thinking” (p. 6). The limbic system is a series of neural circuits that make possible the positive emotions that embed pleasure in our lives. Like Proust’s madeleine, our limbic system binds together pleasure, motivation, and long-term memory, so that when something feels good, the limbic system lets us remember it – and to seek it again.

But the limbic system also makes us sitting ducks for the mushrooming number of hook-holders, the entrepreneurs of pleasure who sell “engineered excess” to keep us coming back for more (p. 224). On these hooks hang everything that gives us good feelings (the burst of pleasure from chocolate, or a drug’s intoxicating high), or, more importantly, the substances that banish the blues (the opioids that delay withdrawal, or the drink that lets you forget). In a system Courtwright calls “limbic capitalism,” good feelings are for sale every day, everywhere, at all times, via a “technologically advanced but socially regressive business system in which global industries, often with the help of complicit governments and criminal organizations, encourage excessive consumption and addiction” (p. 6).

This places the average person in a perilous position. A powerful global industrial system views individuals as little more than consumers, and seeks to take as much of their money as possible by repeatedly selling them something, regardless of whether it’s good for them or not. “Every business wants to be the next Cinnabon, selling an irresistibly tempting product,” Courtwright writes. “The products can be legal, illegal, or a bit of both” (p. 229). But by continuously making pleasurable products widely available, Courtwright argues that limbic capitalism disrupts the biological process of hormesis, in which certain chemical compounds are beneficial in small doses but harmful or lethal in large amounts. “In brief, civilized inventiveness weaponized pleasurable products and pastimes,” Courtwright continues. The “age of addiction” is the inevitable result (p. 9).

This engenders one of Courtwright’s most valuable insights, which is that the concept of “addiction” goes far beyond the usual questions of criminal activity, moral relativism, or the disease model. Instead, addictions “begin as journeys, usually unplanned, toward a harmful endpoint on a spectrum of consumption.” In other words, in the realm of limbic capitalism we’re all consumers, and those struggling with addiction have been overwhelmed by their consumption. For Courtwright, “an addiction is a habit that has become a very bad habit, in the sense of being strong, preoccupying, and damaging, both to oneself and others” (p. 3). While this is bad for the individual, it’s very good for business, which is precisely why Courtwright fears limbic capitalism – and the dangerous levels of addiction it produces – is here to stay.

This is natural territory for Courtwright, who has been one of America’s most eloquent chroniclers of the history of drug and alcohol use for decades. But The Age of Addiction expands Courtwright’s focus into other areas – food, gambling, shopping, porn – to show how our desire for pleasure and intoxication has created an unprecedented commercial environment, where unrestrained free market capitalism actively and enthusiastically offers addictive substances and experiences, regardless of their inevitable social toll. For the millions of Americans currently struggling with substance use disorders or other addictions, “the heaviest costs are borne by those who lose control over their consumption, who also happen to be the most socially and genetically vulnerable. If capitalism is socially progressive, limbic capitalism is often socially regressive. Sometimes it is savagely so” (p. 227).

The Age of Addiction offers dire warnings about our society, but it does so in elegant and often witty language. Only someone like Courtwright, with his lengthy career and deep knowledge, could draw the line of addiction studies between the moment when Neanderthals and homo sapiens were first crossbreeding to Nora Volkow and the National Institute on Drug Abuse today. Courtwright also uses non-traditional rhetorical devices to make his points – two instances of dialogue between fictional combatants are particularly fun to read – to make it clear that this book, written as Courtwright retired from the University of North Florida, is the work of a master scholar who has dedicated his career to illuminating drug history and is now having fun as he expands his scope.

Courtwright was honest about the reactions his ideas first provoked. In one of the dialogues, he quotes a critic who complained, “I wrote on the title page of your manuscript, ‘NO SOLUTIONS’” (p. 225). In response to the threat of limbic capitalism, which clearly values profits over health, Courtwright offers few alternatives, though he agrees with the drug policy expert Mark A. R. Kleiman, who argued thirty years ago for Americans to take a stand “against excess” (p. 246). Still, limbic capitalism’s millenia-long path to offer us a constant smorgasbord of tempting, if dangerous, delights wouldn’t have happened if there weren’t buyers – supply exists because of demand – and I wished Courtwright had mentioned some of the people who have successfully found a way out of limbic capitalism’s grasp. For example, Physician Health Programs are immensely effective at helping individuals overcome drug addictions, and anti-consumerism organizations like Adbusters and Reverend Billy and the Church of Stop Shopping have denounced the dangers of unfettered capitalism for decades.

Nonetheless, the primary contribution of The Age of Addiction is a vastly important one. Courtwright has long been America’s leading voice on the history of drugs, and now he has shown how, in the world of limbic capitalism, addiction is promoted as a marketing tool for a wide variety of products, ones that guarantee customers, often for life. But there is a way out. If we can understand that we’re being used – by the companies, cartels and conglomerates who see us less as people and more like walking ATMs – the most radical action we can take is to stop buying what we’re being sold.


Emily Dufton holds a PhD in American Studies from George Washington University. She is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017), and is currently working on Addiction, Inc.: Medication-Assisted Treatment and the War on Drugs, which was awarded a J. Anthony Lukas Work-in-Progress Award in 2021.

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